PROJECT SUMMARY/ABSTRACT Globally, extreme-heat and extreme-precipitation events have a large impact on human health. Adaptation to climate change is a national priority in light of the National Climate Assessment?s findings of significant climate- change-related health burdens among the most disadvantaged populations. This persistent and growing public health problem is especially concerning given the following: increasing temperatures and extreme-heat and extreme-precipitation events with climate change; increasing numbers of elderly individuals in the U.S. population; and increasing urbanization. Adaptation and intervention strategies must be informed by high quality science. However, research in this area to date is limited by a lack of fine spatial resolution data on the full range of factors that play into climate change vulnerability, including: health outcomes ranging from illness to death; patient characteristics; temperature and precipitation exposures; and environmental and housing information. Additionally, the experiences of affected communities and the usability of research products, including vulnerability maps, are not always integrated into the research process, nor is research always adequately translated into actions to reduce adverse effects of heat, particularly for vulnerable populations. This project will fill knowledge gaps through analysis of a novel dataset with finely resolved information informed by community knowledge and policy needs. Dr. Gronlund will identify how pre-existing health conditions, housing characteristics and air pollution increase vulnerability to extreme heat mortality, hospitalization and emergency room visits, using data from 6 U.S. cities. She will link mortality records and Medicare records in each city to a fine-scale model of daily temperature exposure and publicly available housing data. Data and statistical methods will allow her to study these potential vulnerability characteristics at the level of both the individual and the neighborhood. She will account for competing effects between mortality and morbidity events and examine how socioeconomic disparities in heat health effects are mediated, or explained, by more direct mechanisms such as housing quality and pre-existing health conditions. Based on this information, she will generate heat risk scores for each neighborhood in the six cities and map these risks. She will also identify how housing age, as a proxy for plumbing quality, modifies associations between precipitation and gastrointestinal hospitalization and emergency room visits. In Detroit, MI, she will also engage with the community at each step of the research process in a participatory, co-educational manner that will ensure that her specific research questions will both incorporate the knowledge and address relevant needs of local community members and officials involved in climate adaptation planning. Dr. Gronlund has background in epidemiologic research on the health effects of heat. In the first two years of the award, she will obtain additional training in spatial statistics, climate science and community-based participatory research methods from highly qualified mentors. The results from this research will help cities adapt to changing climatic and demographic conditions by providing guidance to health care providers and the general public on which health and housing characteristics increase susceptibility to heat and by informing sustainable climate change adaptation efforts.